Community-Level Social Determinants of Health Impact on Risk of Pregestational, Gestational Diabetes

Individuals who have never given birth and live in neighborhoods with a greater socioeconomic disadvantage have an increased risk of developing pregestational and gestational diabetes, new research published in the American Journal of Obstetrics & Gynecology MFM found.¹

Pregestational and gestational diabetes impact 1% to 2% and 2% to 10% of all pregnant women in the United States, respectively.^2,3 Both conditions can increase the risk of adverse pregnancy outcomes and have been associated with adverse social determinants of health. However, it is not currently known if community-level social determinants of health impact the risk of these conditions.

“Individuals living in neighborhoods with greater socioeconomic disadvantage, food deserts, and less walkability, experience a higher burden of proximal social determinants of health,” the authors wrote. “Elucidating the impact of neighborhood social determinants of health on the risk of [diabetes] and gestational diabetes is important to inform and facilitate policy and structural interventions to improve perinatal health.”

A team of investigators conducted a study to determine whether living in neighborhoods with greater socioeconomic disadvantage, food deserts, or less walkability was associated with having pregestational diabetes and developing gestational diabetes. Data was gathered from the Nulliparous Pregnancy Outcomes Study, a cohort study examining adverse pregnancy outcomes in pregnant women with no previous pregnancy lasting 20 or more weeks.

Investigators looked at 3 different community-level exposures: socioeconomic disadvantage determined by the Area Deprivation Index, food desert defined by the United States Department of Agriculture Food Access Research Atlas, and less walkability defined by the Environmental Protection Agency National Walkability Index. The study cohort included 9155 participants with a mean Area Deprivation Index score of 39. Of those participants, 37% lived in a food desert and 41% lived in a less walkable neighborhood.

Investigators found that the frequency of pregestational and gestational diabetes diagnosis was 1.5% and 4.2%, respectively. Participants living in neighborhoods with the highest level of socioeconomic disadvantage had an increased risk of entering pregnancy with pregestational diabetes. Participants living in a food desert and in a less walkable neighborhood also had increased risk of gestational diabetes.

Additionally, there was no significant association between living in a food desert or a less walkable neighborhood and pregestational diabetes, as well as between socioeconomic disadvantage and gestational diabetes.

“[T]hese findings highlight the impact of the broader environment even before pregnancy on the risk of [diabetes] and the need for policies to support vulnerable communities,” the authors concluded. “Findings from this study and others that demonstrate a relationship between community-level measures and adverse health outcomes should encourage health care workers to actively seek out opportunities to collaborate with policymakers and community planners in decisions related to the social and structural environment in their communities.”

References

1. Field C, Grobman WA, Yee LM, et al. Community-level social determinants of health and pregestational and gestational diabetes. Am J Obstet Gynecol MFM. Published online December 7, 2023. doi:10.1016/j.ajogmf.2023.101249

2. Hart BN, Shubrook JH, Mason T. Pregestational Diabetes and Family Planning. Clin Diabetes. 2021;39(3):323-328. doi:10.2337/cd20-0062

3. Akinyemi OA, Weldeslase TA, Odusanya E, et al. Profiles and Outcomes of Women with Gestational Diabetes Mellitus in the United States. Cureus. 2023;15(7):e41360. Published 2023 Jul 4. doi:10.7759/cureus.41360